Category: Appraising Change: The Book

4.3 Writing a Goal Statement

A is a succinctly written version of your intervention plan used to convey the information essential to describing the treatment target, the intervention procedures and the outcome criteria. Goal statements can be used to address the spectrum of your client’s needs: the acquisition of target behavior in a specific therapy activity of a treatment outcome,

4.99 Epilogue: Formulating Treatment Goals

In this chapter, I’ve tried to show how outcomes and goals can be used to develop an organized intervention approach for your client. As discussed in 4.1, it is critical to locate your interventions within the larger scope of the client’s functional skills, to map out the interdependencies between the client’s needs, their existing constellation of physical,

5.0 Developing Observation-Based Tracking Plans

Case Study:Tracking Dilemmas

Laura and her colleagues are sitting in the library developing their first treatment plans for their clients. Although they have a pretty good idea about their client’s treatment goals, figuring out why, what and how to track remains a challenge:

Laura: Ok, I’ve identified JJ’s speech goals. Now my clinic supervisor said to come up with 5 to 6 different activities and games to help him practice his speech.

5.1 Basics of Observation-based Tracking

Much of the assessment of client progress and clinical change comes about through behavioral observation. It could be the direct observation of the client’s response elicited during structured therapy, tracking the communicative behaviors produced during social play, recording the duration of vocalization, or making judgements about the client’s communicative performance, success and/or difficulty. In this section,

5.2 Direct Behavior Observation: Event Recording

The direct observation of a behavioral event utilize the client’s behavior as the unit of analysis. We are interested in reporting the occurrence of a behavior so that it can be counted and compared to other behaviors, or proportion of occasions that it occurred. Event recording strategies work best for behaviors that are observationally distinct and relatively short in duration,

5.3 Direct Behavior Observation: Measuring Time & Behavior

All behavior has a durative (i.e., time-based) component. However for many types of therapy, time may not be important to measure directly. Indeed, counting the the correct productions of an articulation target or the percent of appropriate responses to questions don’t involve any sort of time-based measurement. Rather, they require direct observation event recording strategies.

5.4 Indirect Behavior Observation: Rating Scales

Individualized Rating Scales

Individualized Rating Scales (IRS) can be designed to capture the distinct qualities of a client’s problem which can be used by the client and others to rate their success over time. As noted by Orme and Combs-Orme (2012), IRSs are easy to develop and can be used to identify and assess individualized problems across a wide range of clients.

5.99 Epilogue: Observation-Based Tracking Plans

A tracking plan consists of the observation and data collection procedures used to behavioral data to determine whether your client is making progress related to your treatment and functional communication goals. In order provide valid and reliable data for analysis, a tracking plan should be designed to capture and characterize critical clinical changes, be unbiased but sensitive to important behavior changes,

6.0 Assessing Client Performance: Introduction

Case Study: Intermittent Progress

For the last 5 years, Sue started out her treatment program the same way as she was taught in grad school: First, use the first therapy session as baseline, then continue therapy until winter break, modifying the student’s program along the way. If the student (MJ) meets their objective, then advance their therapy to meet a new goal.

6.1 Assessing Client Performance: Graphing Basics

Simple Baseline – Treatment (A|B) Graph

When a particular behavior is observed and measured over time, this information is called a data series. Two appear on the above: (1) the and collected on AD’s articulation performance during a therapy task, and (2) a of her articulation performance during classroom activities. within each series are graphed using the same symbols and connected by a line.

6.2 Measurement Basics: Level, Trend, Variability, Phase Length

To answer Olswang and Bain’s questions, we use to determine whether there is a notable increase or decrease in our client’s therapy performance over time, and/or whether there is a significant difference between (e.g., vs ). Our confidence in making these decisions depends, in part, on the number of data points being evaluated and the variability of the client’s performance within a phase.

6.3 Single Case Design Basics

… Often the task of scientist-practitioners is not so much to change their methods of clinical investigation in order to conduct empirically meaningful evaluations, but merely to recognize and make explicit the scientific logic of their practical work. Hayes, Barlow & Nelson-Gray, 1999, p. 137)

In this section we will deal with several useful (SCDs) for evaluating speech language interventions.

6.4 Assessing Client Performance: Treatment-Only Design (B)

Introduction: Does My Client’s Performance Change Over Time?

Starting therapy without first taking baseline data is often misunderstood, both in terms of its utility, as well as its limitations. To its credit, a Treatment-Only approach may be justified if the client is in crisis or if the client’s condition is well understood and there isn’t much need to collect baseline data.

6.5 Evaluating Clinical Change: Using a Simple Phase-Change (A|B) Design

Considerations Involving the Simple Phase-Change (A|B) Design

The strategy is comprised of two phases, typically a (A) phase and a (B) phase. The baseline phase serves as a control to compare against the client’s performance when receiving intervention services. In addition, the client may be observed post-treatment to assess stability and generalization. As will be shown below,

6.6 Designs to Match Treatment Programs and Address Specific Questions

In the previous sections we used the to address relatively straightforward issues about behavior change in response to a single intervention (e.g., is my client improving?, Is he responding to the treatment regime?). The A|B Design can also be modified to address a variety of tracking and evaluation situations commonly dealt with in our day-to-day work with clients.